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The Sequester Hits the Reservation

The Congressional Republicans who brought us the mindless budget cuts known as the sequester have shown remarkable indifference to life-sustaining government services, American jobs and other programs. So what do they make of the country’s commitments to American Indians, its longstanding obligations to tribal governments under the Constitution and treaties dating back centuries?

Very little, it seems. The sequester will impose cuts of 5 percent across the Indian Health Service, the modestly financed agency within the United States Department of Health and Human Services that provides basic health care to two million American Indians and native Alaskans. It is underfinanced for its mission and cannot tolerate more deprivation.

Here lies a little-noticed example of moral abdication. The biggest federal health and safety-net programs — Social Security, Medicaid, the Children’s Health Insurance Program, the Supplemental Nutrition Assistance Program, Supplemental Security Income, and veterans’ compensation and health benefits — are all exempt from sequestration. But the Indian Health Service is not.

The agency was supposed to be spared the worst of the automatic cuts; at least that is what its officials believed. Under a 1985 law that served as the model for the current sequester, annual cuts to appropriations for the Indian Health Service could not exceed 2 percent.

Even a cut of that amount is very bad news for the main health care provider for some of the poorest and sickest Americans, living in some of the most remote and medically underserved parts of the country. Like care for veterans, Indian health was supposed to be one area in which duty and compassion trumped cheapness.

The agency’s officials were braced for that level of cuts, but they were mistaken. The Office of Management and Budget interpreted the sequestration law to mean that the 2 percent cap did not apply to most of the Indian Health Service financing.

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The agency’s director, Yvette Roubideaux, had to warn tribal leaders last September to plan for a much bigger, $220 million cut, which it expects will lead to 3,000 fewer inpatient admissions and 804,000 fewer outpatient visits each year.

The Indian Health Service operates 320 health centers, 45 hospitals, 115 health stations and 4 school health centers across the country. The vast majority of these are on reservations, where poverty, disease, substance abuse, suicide and other public health challenges are severe.

The government has been increasing its support for the service in the last decade; at a hearing on Tuesday of the House Appropriations Subcommittee on Interior, Environment and Related Agencies, the chairman, Mike Simpson, an Idaho Republican, noted that between 2000 and 2012, financing rose to $4.4 billion from $2.4 billion.

This has allowed some improvement and stability in services. But Dr. Roubideaux told Mr. Simpson that the agency’s catastrophic health emergency fund, which reimburses providers for trauma care and major surgeries, would still run out of money before the end of the year.

The federal government cannot use its budget nihilism to avoid its moral and legal obligations.

A version of this editorial appears in print on March 21, 2013, on Page A26 of the New York edition with the headline: The Sequester Hits the Reservation. Today's Paper|Subscribe